Feds arrest scores in $14 billion Medicare/Medicaid fraud. South Florida high on list
The Justice Department on Monday unveiled new healthcare fraud charges against 324 defendants nationwide, including 37 in South Florida, who were recently arrested as part of the government's annual take-down initiative.
Overall, Justice Department officials said 96 doctors, nurses and pharmacists were among those arrested across all 50 states.
Authorities said the defendants submitted more than $14.6 billion in falsified bills to the federal Medicare and Medicaid programs as well as to private insurers, describing the magnitude of fraud as the 'largest' in U.S. history — more than double the prior record of $6 billion.
The alleged schemes, fueled by stolen identities, financial kickbacks and fabricated bills, continue to plague the medical equipment, genetic testing and painkiller sectors, among others.
READ MORE: Kendall companies and doctors pay $810,000 to settle Medicare fraud charges
In a statement, Attorney General Pam Bondi described the array of defendants as 'criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers.'
Agents with the FBI and Health and Human Services seized more than $245 million in cash, luxury vehicles, cryptocurrency and other assets nationwide, authorities said during a news conference in Washington on Monday.
But while that number may seem huge, it pales next to the government's losses to healthcare fraud every year, according to experts. South Florida, often described as the capital of fraud, continues to be among the hardest-hit regions in the country.
For all of its resources committed to fighting the schemes, including data analytics, the federal Medicare and Medicaid programs for the elderly and indigent continue to lose untold sums to fraud, waste and abuse because they routinely pay bills quickly — leaving law enforcement to chase after offenders who cheat the system after payments land in their pockets.
Authorities say the Centers for Medicare and Medicaid Services has reduced the rate of 'improper payments' — a combination of 'fraud, waste and abuse' — to 7.46% for the 2022 fiscal year compared with 9.51% in fiscal year 2017, the latest comparisons available.
But the federal agency has never publicly disclosed the total amount of improper payments that should not have been made or were made in the wrong amount. Experts estimate that CMS, with an annual budget of $850 billion funded with payroll taxes, loses tens of billions yearly as a result of improper payments.
Here are a few South Florida cases filed by the U.S. Attorney's Office in Miami during the national take-down:
▪ Dave Sudarshan Singh, 37, of Pembroke Pines, was charged on Thursday with conspiracy to commit healthcare and money laundering for submitting false claims to Medicare for over-the-counter COVID-19 tests — tests that beneficiaries, including some who were deceased, had not requested.
An indictment accused Singh and others of using his business, MDP Products and Services, Inc., to file over $14.1 million in bogus claims to Medicare between 2022 and 2023. Medicare, in turn, paid Singh's business about $13 million for the over-the-counter tests, which did not qualify for reimbursements, prosecutors said. His arraignment is pending.
▪ Lazaro Delgado, 59, of Miami, was charged last week with conspiracy to commit health care fraud, alleging he and others submitted false Medicare and Medicaid bills for orthotic braces on behalf of unsuspecting beneficiaries. Prosecutors said Delgado acted as an intermediary to place a nominal owner as the head of Hucel Custom Med Inc., while other co-conspirators coordinated the phony claims for durable medical equipment products that the beneficiaries did not need.
In 2022, Hucel fraudulently billed Medicare/Medicaid for about $9 million worth of orthotic braces and received government reimbursements of $1.8 million. His arraignment is pending.
▪ Marlen Veliz Rios, 58, of Hialeah, owner of Loves Community Health Mental Health Inc., was charged last week with health care fraud and conspiracy to commit money laundering. An indictment accused Veliz Rios of scheming with others to bill more than $15.3 million worth of wound care and skin graft products on behalf of Medicare beneficiaries who never did not need them or receive them.
As a result, Medicare paid her company about $10 million. Further, the indictment accused Veliz Rios of transferring the money from Loves' bank account to shell companies under her control and then to others in the alleged laundering scheme. As part of the probe, federal agents have seized $4.6 million from her various accounts, prosecutors said. Her arraignment is pending.
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